Provider Demographics
NPI:1932390176
Name:MAISTO FAMILY MEDICAL, LTD.
Entity Type:Organization
Organization Name:MAISTO FAMILY MEDICAL, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAISTO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-655-6247
Mailing Address - Street 1:7785 W SAHARA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2788
Mailing Address - Country:US
Mailing Address - Phone:702-655-6247
Mailing Address - Fax:702-655-2410
Practice Address - Street 1:7785 W SAHARA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2788
Practice Address - Country:US
Practice Address - Phone:702-655-6247
Practice Address - Fax:702-655-2410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVH48907Medicare UPIN